Obesity Counseling: Wasteful?

Last week, the Centers for Medicare and Medicaid Services (CMS) — the federal agency that runs Medicare — announced that Medicare will begin to cover behavioral therapy and dietary counseling for people who are obese (defined by a body-mass index of 30 or higher). This announcement comes as no surprise, as CMS proposed covering such treatments in September and offered a 90-day comment period. Nevertheless, some of the details of how Medicare will cover treatments are attracting fresh criticism.

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According to an article at MedPage Today, obese Medicare enrollees will now be able to receive weekly behavioral-therapy counseling in a primary-care setting for one month, followed by further sessions every two weeks for the next five months. If the person loses at least 3 kilograms (6.6 pounds) during these six months, Medicare will cover monthly sessions for another six months. All of these counseling sessions will be covered completely by Medicare, with no co-pays.

Peter Jacobson, a health policy professor interviewed for the MedPage Today article, took issue with Medicare’s coverage only of counseling that takes place in a primary-care setting, calling this “necessary but not sufficient to address the obesity epidemic.” Covering specialty practices and counseling centers, he noted, could lead to more effective treatments. Robert Eckel, MD, a former president of the American Heart Association, doubted that the treatments offered by Medicare would lead to sustained weight loss after the first year and worried that they would simply cost the program money without resulting in better health. And health policy professor Robert Field noted that people who are obese at an advanced age — those covered by Medicare — would most likely need to break lifelong habits to achieve significant weight loss, a tall order.

The decision to cover obesity-related counseling under Medicare comes on the heels of two discouraging research announcements. One is that according to the most recent Gallup-Healthways Well-Being Index — based on surveys conducted in the US, Britain, and Germany — a quarter of Americans are obese. As noted in an article from UPI, the survey found that 25% of Americans were obese, compared with 20% of Britons and just over 10% of Germans. Furthermore, obese survey respondents were more than twice as likely to have high blood pressure, to have high cholesterol, or to have had a heart attack — and six times as likely to have diabetes — as those who were not obese.

Separately, last month a Bloomberg article described how a growing number of scientists believe that processed and sugary foods and drinks have addictive properties that mirror those of drugs such as cocaine and nicotine, based on studies that have compared brain scans of obese people and compulsive eaters with those of drug addicts. As the article notes, companies that sell processed foods are quick to point out their healthier offerings — but, in a typical example, PepsiCo uses roughly 80% of its marketing budget to promote snack foods and soft drinks. Naturally, the industry disputes the idea that its products are addictive and rejects calls to label or regulate its products as such.

What do you think — is Medicare’s new coverage of obesity-related counseling the right move, or likely not to make such of a difference? Should private health insurance companies be required to offer obesity-related counseling as well? Given the severity of the US obesity epidemic, are more drastic measures called for — such as labeling certain junk foods as dangerous, restricting their advertising, or imposing a special tax on them? Leave a comment below!

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